Abstract
The link between adult attachment and depression in elderly populations is well-entrenched in scholarly literature. However, there is a limited understanding of the mediating and moderating pathways underpinning this relation. This study investigated the mediating effect of cognitive reappraisal and moderating effect of social connectedness in the association between adult attachment and depressive symptomology among Pakistani community-dwelling older parents. A population-based correlational study was conducted in the vicinity of Rawalpindi. The study employed a multistage cluster sampling approach to gather data from a total sample of 400 community-dwelling parents who were either 60 years old. Questionnaire-based interviews were carried out by using the Experiences in Close Relationships Questionnaire, Emotion Regulation Questionnaire, Lubben Social Network Scale, and Geriatric Depression Scale. Findings indicated that cognitive reappraisal significantly mediated the relation between adult attachment and depressive symptomology. Moreover, when social connectedness moderated the relationship, only the indirect effect of attachment avoidance – not attachment anxiety – had a significant impact on depressive symptoms via cognitive appraisal. This study illustrated the importance of considering adult attachment in predicting depressive symptoms in older parents. Additionally, findings showed that cognitive reappraisal and social connectedness could serve as protective factors in alleviating depressive symptoms. Psychogeriatric practitioners may embed attachment orientations through cognitive reappraisal and social linkages in intervention programs to minimize depression symptomology amongst older parents in community settings.
Similar content being viewed by others
Data availability
Data and materials for the present study have not been made publicly available due to privacy concerns. Data analyzed in the current study are available on request from the corresponding author via email at dr.sumara@s3h.nust.edu.pk.
References
American Psychiatric Association (2022). Diagnostic and statistical manual of mental disorders. Fifth edition, text revision (DSM-5-TR™) (Revised ed.). American Psychiatric Association Publishing.
Ashida, S., & Heaney, C. A. (2008). Differential associations of social support and social connectedness with structural features of social networks and the health status of older adults. Journal of Aging and Health, 20(7), 872–893. https://doi.org/10.1177/0898264308324626
Assariparambil, A. R., Noronha, J. A., Kamath, A., Adhikari, P., Nayak, B. S., Shankar, R., & George, A. (2021). Depression among older adults: A systematic review of south asian countries. Psychogeriatrics, 21(2), 201–219. https://doi.org/10.1111/psyg.12644
Bartholomew, K., & Horowitz, L. M. (1991). Attachment styles among young adults: A test of a four-category model. Journal of Personality and Social Psychology, 61(2), 226. https://doi.org/10.1037/0022-3514.61.2.226
Barua, A., Ghosh, M. K., Kar, N., & Basilio, M. A. (2011). Prevalence of depressive disorders in the elderly. Annals of Saudi medicine, 31(6), 620–624. https://doi.org/10.4103/0256-4947.87100
Bech, P., Olsen, L. R., Kjoller, M., & Rasmussen, N. K. (2003). Measuring well-being rather than the absence of distress symptoms: A comparison of the SF‐36 Mental Health subscale and the WHO‐Five well‐being scale. International Journal of Methods in Psychiatric Research, 12(2), 85–91. https://doi.org/10.1002/mpr.145
Besser, A., & Priel, B. (2008). Attachment, depression, and fear of death in older adults: The roles of neediness and perceived availability of social support. Personality and Individual Differences, 44(8), 1711–1725. https://doi.org/10.1016/j.paid.2008.01.016
Birnbaum, G. E., Orr, I., Mikulincer, M., & Florian, V. (1997). When marriage breaks up-does attachment style contribute to coping and mental health? Journal of Social and Personal Relationships, 14(5), 643–654. https://doi.org/10.1177/0265407597145004
Blazer, D. G. (2003). Depression in late life: Review and commentary. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 58(3), M249–M265. https://doi.org/10.1093/gerona/58.3.M249
Borawski, D., Sojda, M., Rychlewska, K., & Wajs, T. (2022). Attached but Lonely: Emotional Intelligence as a Mediator and Moderator between Attachment Styles and Loneliness. International Journal of Environmental Research and Public Health, 19(22), 14831. https://doi.org/10.3390/ijerph192214831
Brink, T. L., Yesavage, J. A., Lum, O., Heersema, P. H., Adey, M., & Rose, T. L. (1982). Screening tests for geriatric depression. Clinical Gerontologist, 1(1), 37–43. https://doi.org/10.1300/J018v01n01_06
Bruggencate, T., Luijkx, K. G., & Sturm, J. (2018). Social needs of older people: A systematic literature review. Ageing & Society, 38(9), 1745–1770. https://doi.org/10.1017/S0144686X17000150
Cacioppo, J. T., & Cacioppo, S. (2014). Social relationships and health: The toxic effects of perceived social isolation. Social and Personality Psychology Compass, 8(2), 58–72. https://doi.org/10.1111/spc3.12087
Cacioppo, J. T., Hawkley, L. C., & Thisted, R. A. (2010). Perceived social isolation makes me sad: 5-year cross-lagged analyses of loneliness and depressive symptomatology in the Chicago Health, Aging, and Social Relations Study. Psychology and Aging, 25(2), 453–463. https://doi.org/10.1037/a0017216
Charles, S. T., & Carstensen, L. L. (2010). Social and emotional aging. Annual Review of Psychology, 61(1), 383–409. https://doi.org/10.1146/annurev.psych.093008.100448
Chen, Y., Hicks, A., & While, A. E. (2014). Loneliness and social support of older people living alone in a county of Shanghai, China. Health and Social Care in the Community, 22(4), 429–438. https://doi.org/10.1111/hsc.12099
Cheruvu, V. K., & Chiyaka, E. T. (2019). Prevalence of depressive symptoms among older adults who reported medical cost as a barrier to seeking health care: Findings from a nationally representative sample. BMC Geriatrics, 19(1), 1–10. https://doi.org/10.1186/s12877-019-1203-2
Collins, N. L., & Feeney, B. C. (2000). A safe haven: An attachment theory perspective on support seeking and caregiving in intimate relationships. Journal of Personality and Social Psychology, 78(6), 1053–1073. https://doi.org/10.1037/0022-3514.78.6.1053
Coyle, C. E., & Dugan, E. (2012). Social isolation, loneliness and health among older adults. Journal of Aging and Health, 24(8), 1346–1363. https://doi.org/10.1177/0898264312460275
Davis, T. J., Morris, M., & Drake, M. M. (2016). The moderation effect of mindfulness on the relationship between adult attachment and wellbeing. Personality and Individual Differences, 96, 115–121. https://doi.org/10.1016/j.paid.2016.02.080
Diener, E. D., Scollon, C., & Lucas, R. E. (2003). The evolving concept of subjective well-being: The multifaceted nature of happiness. Advances in Cell Aging and Gerontology, 15, 187–219. https://doi.org/10.1016/s1566-3124(03)15007-9
Ebenstein, A., & Leung, S. (2010). Son Preference and Access to Social Insurance: Evidence from China’s Rural Pension Program. Population and Development Review, 36(1), 47–70. https://doi.org/10.1111/j.1728-4457.2010.00317.x
Fraley, R. C., Heffernan, M. E., Vicary, A. M., & Brumbaugh, C. C. (2011). The experiences in close relationships-relationship structures questionnaire: A method for assessing attachment orientations across relationships. Psychological Assessment, 23(3), 615–625. https://doi.org/10.1037/a0022898
Ganatra, H. A., Zafar, S. N., Qidwai, W., & Rozi, S. (2008). Prevalence and predictors of depression among an elderly population of Pakistan. Aging and Mental Health, 12(3), 349–356. https://doi.org/10.1080/13607860802121068
Gross, J. J. (1998). The emerging field of emotion regulation: An integrative review. Review of General Psychology, 2(3), 271–299. https://doi.org/10.1037/1089-2680.2.3.271
Gross, J. J., & John, O. P. (2003). Individual differences in two emotion regulation processes: Implications for affect, relationships, and well-being. Journal of Personality and Social Psychology, 85(2), 348–362. https://doi.org/10.1037/0022-3514.85.2.348
Grover, S., & Malhotra, N. (2015). Depression in elderly: A review of indian research. Journal of Geriatric Mental Health, 2(1), 4. https://doi.org/10.4103/2348-9995.161376
Hassan, S. M. U., Hamid, T. A., Haron, S. A., & Ibrahim, R. (2020). Emotional regulation as a mediator between the filial behavior of the oldest son and subjective well-being of older parents in Pakistan. Psychogeriatrics, 20(1), 59–69. https://doi.org/10.1111/psyg.12458
Hassan, S. M. U., Hamid, T. A., Haron, S. A., & Ibrahim, R. (2021). Relationship between filial responsibility, self-esteem, emotional regulation, and subjective well-being among Pakistani community dwelling older adults. (Doctoral dissertation). University Putra Malaysia, Malaysia. Retrieved from https://psasir.upm.edu.my/id/eprint/84515/.
Hayat, M. U. N., & Muhammad, S. (2014). Emotional regulation, empathy, and altruism among adults: A pilot study (Unpublished masters thesis). Fatima Jinnah Women University, Rawalpindi, Pakistan.
Hayes, A. F. (2013). Mediation, moderation, and conditional process analysis. Introduction to mediation, moderation, and conditional process analysis: A regression-based approach (1st ed., p. 20). Guilford Publications.
Hayes, A. F. (2018). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach (2nd ed.). Guilford Press.
Herero, V. G., & Extremera, N. (2010). Daily life activities as mediators of the relationship between personality variables and subjective well-being among older adults. Personality and Individual Differences, 49(2), 124–129. https://doi.org/10.1016/j.paid.2010.03.019
Hu, T., Zhang, D., Wang, J., Mistry, R., Ran, G., & Wang, X. (2014). Relation between emotion regulation and mental health: A meta-analysis review. Psychological Reports, 114(2), 341–362. https://doi.org/10.2466/03.20.pr0.114k22w4
Itrat, A., Taqui, A. M., Qazi, F., & Qidwai, W. (2007). Family Systems: Perceptions of elderly patients and their attendents presenting at a university hospital in Karachi, Pakistan. Journal of the Pakistan Medical Association, 57(2), 106–110.
Javed, S., & Mustafa, N. (2013). Prevalence of depression in various demographic variables among elderly. Open Access Scientific Reports, 2(1), 1–4.
Jinyao, Y., Xiongzhao, Z., Auerbach, R. P., Gardiner, C. K., Lin, C., Yuping, W., & Shuqiao, Y. (2012). Insecure attachment as predictor of depressive and anxious symptomatology. Depression and Anxiety, 29(9), 789–796. https://doi.org/10.1002/da.21953
Joormann, J., & Stanton, C. H. (2016). Examining emotion regulation in depression: A review and future directions. Behaviour Research and Therapy, 86, 35–49. https://doi.org/10.1016/j.brat.2016.07.007
Kafetsios, K., & Sideridis, G. D. (2006). Attachment, social support and well-being in young and older adults. Journal of Health Psychology, 11(6), 863–875. https://doi.org/10.1177/1359105306069084
Karreman, A., & Vingerhoets, A. J. (2012). Attachment and well-being: The mediating role of emotion regulation and resilience. Personality and Individual Differences, 53(7), 821–826. https://doi.org/10.1016/j.paid.2012.06.014
Khattri, J. B. (2006). Study of depression among geriatric population in Nepal. Nepal Medical College Journal, 8(4), 220–223.
Lubben, J. E. (1988). Assessing social networks among elderly populations. Family and Community Health, 11(3), 42–52.
Lukaschek, K., Vanajan, A., Johar, H., Weiland, N., & Ladwig, K. H. (2017). In the mood for ageing: Determinants of subjective well-being in older men and women of the population-based KORA-Age study. BMC Geriatrics, 17(1), 1–9. https://doi.org/10.1186/s12877-017-0513-5
Marroquín, B., Tennen, H., & Stanton, A. L. (2017). Coping, emotion regulation, and well-being: Intrapersonal and interpersonal processes. The happy mind: Cognitive contributions to well-being (pp. 253–274). Springer. https://doi.org/10.1007/978-3-319-58763-9_14
Marroquín, B., De Rutte, J., May, C. L., & Wisco, B. E. (2019). Emotion regulation in context: Social connectedness moderates concurrent and prospective associations with depressive symptoms. Journal of Social and Clinical Psychology, 38(7), 605–626. https://doi.org/10.1521/jscp.2019.38.7.605
Merz, E. M., & Consedine, N. S. (2012). Ethnic group moderates the association between attachment and wellbeing in older adults. Cultural Diversity & Ethnic Minority Psychology, 18(4), 404–415. https://doi.org/10.1037/a0029595
Merz, E. M., Schuengel, C., & Schulze, H. J. (2007). Intergenerational solidarity: An attachment perspective. Journal of Aging Studies, 21(2), 175–186. https://doi.org/10.1016/j.jaging.2006.07.001
Mikulincer, M., & Shaver, P. R. (2003). The attachment behavioral system in adulthood: Activation, psychodynamics, and interpersonal processes. In M. Zanna (Ed.), Advances in experimental social psychology (pp. 53–152). Academic. https://doi.org/10.1016/S0065-2601(03)01002-5
Mikulincer, M., & Shaver, P. R. (2007). Attachment in adulthood: Structure, dynamics, and change. Guilford Press.
Mikulincer, M., & Shaver, P. R. (2010). Attachment in adulthood: Structure, dynamics, and change. Guilford Publications.
Mikulincer, M., Shaver, P. R., & Pereg, D. (2003). Attachment theory and affect regulation: The dynamics, development, and cognitive consequences of attachment-related strategies. Motivation and Emotion, 27(2), 77–102. https://doi.org/10.1023/A:1024515519160
Nanji, K., Kadir, M., Ahmed, K., & Naqvi, H. (2011). Factors associated with depression among elderly in Karachi Pakistan: A matched case control study. Journal of Epidemiology & Community Health, 65(1), 394–394. https://doi.org/10.1136/jech.2011.142976n.49
Pakistan Health Profile (2012). Updated on May 2012. http://www.who.int/gho/countries/pak.pdf
Pakistan Bureau of Statistics (2017). Household Integrated Economic Survey (HIES) 2015-16 Retrieved from https://www.pbs.gov.pk/publication/household-integrated-economic-survey-hies-2015-16
Pearlin, L. I., & Schooler, C. (1978). The structure of coping. Journal of Health and Social Behavior, 2–21. https://doi.org/10.2307/2136319
Peil, K. T. (2014). Emotion: The self-regulatory sense. Global Advances in Health and Medicine, 3(2), 80–108. https://doi.org/10.7453/gahmj.2013.058
Peltzer, K., & Phaswana-Mafuya, N. (2013). Depression and associated factors in older adults in South Africa. Global Health Action, 6(1), 18871. https://doi.org/10.3402/gha.v6i0.18871
Peng, J., Zhang, J., Zhao, K., Wang, X., Wu, Y., Fang, P., & Lv, J. (2021). The impact of attachment on depression in married seniors: chain mediating effects of self-esteem and rumination. Frontiers in Psychology, 12. https://doi.org/10.3389/fpsyg.2021.677015
Qadir, F., Haqqani, S., Khalid, A., Huma, Z., & Medhin, G. (2014). A pilot study of depression among older people in Rawalpindi, Pakistan. BMC Research Notes, 7(1), 1–9. https://doi.org/10.1186/1756-0500-7-409
Scheffold, K., Philipp, R., Koranyi, S., Engelmann, D., Schulz-Kindermann, F., Härter, M., et al. (2018). Insecure attachment predicts depression and death anxiety in advanced cancer patients. Palliative & Supportive Care, 16, 308–316. https://doi.org/10.1017/S147895151700028
Seppala, E., Rossomando, T., & Doty, J. R. (2013). Social connection and compassion: Important predictors of health and well-being. Social Research: An International Quarterly, 80(2), 411–430. https://doi.org/10.1353/sor.2013.0027
Sharif, S., Amiri, M., Allen, K. A., Sharif, N. H., Khoshnavay, F., Hatef, M. Y., & Waheed, H. (2021). Attachment: The mediating role of hope, religiosity, and life satisfaction in older adults. Health and Quality of Life Outcomes, 19(1), 1–10. https://doi.org/10.1186/s12955-021-01695-y
Taqui, A. M., Itrat, A., Qidwai, W., & Qadri, Z. (2007). Depression in the elderly: Does family system play a role? A cross-sectional study. BMC Psychiatry, 7(1), 1–12. https://doi.org/10.1186/1471-244X-7-57
United Nations (2019). World Population Ageing 2019: Highlights. Retrieved from: https://www.un.org/en/development/desa/population/publications/pdf/ageing/WorldPopulationAgeing2019-Highlights.pdf
Urano, Y., & Ikeda, T. (2021). Perceived social support moderates the association between emotion regulation and psychological distress: A cross-sectional study among japanese adults. Psychology Health & Medicine, 26(10), 1195–1205. https://doi.org/10.1080/13548506.2020.1802051
Wei, M., Vogel, D. L., Ku, T. Y., & Zakalik, R. A. (2005). Adult attachment, affect regulation, negative mood, and interpersonal problems: The mediating roles of emotional reactivity and emotional cutoff. Journal of Counseling Psychology, 52, 14–24. https://doi.org/10.1037/0022-0167.52.1.14
Wei, M., Liao, K. Y. H., Ku, T. Y., & Shaffer, P. A. (2011). Attachment, self-compassion, empathy, and subjective well-being among college students and community adults. Journal of Personality, 79, 191–221. https://doi.org/10.1111/j.1467-6494.2010.00677.x
Wickramaratne, P. J., Yangchen, T., Lepow, L., Patra, B. G., Glicksberg, B. S., Talati, A., & Weissman, M. M. (2022). Social connectedness as a determinant of mental health: A scoping review. MedRxiv. https://doi.org/10.1101/2022.01.26.22269896
World Health Organization (2015). World report on ageing and health. Retrieved from https://apps.who.int/iris/bitstream/10665/186463/1/9789240694811eng.pdf?ua¼1
Wu, F., & Sheng, Y. (2019). Social support network, social support, self-efficacy, health-promoting behavior and healthy aging among older adults: A pathway analysis. Archives of Gerontology and Geriatrics, 85, 103934. https://doi.org/10.1016/j.archger.2019.103934
Yesavage, J. A., Brink, T. L., Rose, T. L., Lum, O., Huang, V., Adey, M., & Leirer, V. O. (1982). Development and validation of a geriatric depression screening scale: A preliminary report. Journal of Psychiatric Research, 17(1), 37–49. https://doi.org/10.1016/0022-3956(82)90033-4
Zenebe, Y., Akele, B., & Necho, M. (2021). Prevalence and determinants of depression among old age: A systematic review and meta-analysis. Annals of General Psychiatry, 20(1), 1–19. https://doi.org/10.1186/s12991-021-00375-x
Zhang, X., Chen, X., Ran, G., & Ma, Y. (2016). Adult children’s support and self-esteem as mediators in the relationship between attachment and subjective well-being in older adults. Personality and Individual Differences, 97, 229–233. https://doi.org/10.1016/j.paid.2016.03.062
Zheng, L., Luo, Y., & Chen, X. (2020). Different effects of attachment anxiety and attachment avoidance on depressive symptoms: A meta-analysis. Journal of Social and Personal Relationships, 37(12), 3028–3050. https://doi.org/10.1177/0265407520946482
Zubair, B. U., & Mansoor, S. (2015). Prevalence of depression and associated socio demographic factors in elderly rural population. Journal of Pakistan Psychiatric Society, 12, 19–22.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Ethical approval
This study was conducted following the ethical guidelines provided by the American Psychological Association and the ethical committee of the University Putra Malaysia.
Informed consent
Informed consent was obtained from all individual participants included in the study.
Consent for publication
The authors have agreed upon the publication of this manuscript.
Conflict of interest
The authors have no conflicts to declare.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Ul Hassan, S.M., Jilani, S. & Zubair, M. Adult attachment and depressive symptoms among community-dwelling older parents: a moderated mediation model of cognitive reappraisal and social connectedness. Curr Psychol 43, 8713–8726 (2024). https://doi.org/10.1007/s12144-023-05011-3
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12144-023-05011-3